Universal acetabular guide and associated hardware

ABSTRACT

An orthopedic device includes a patient-specific acetabular guide that may be used for preparing an acetabulum of a patient to receive an acetabular implant. The acetabular guide has a body with an outer three-dimensional surface configured to match an acetabulum of a specific patient&#39;s hip joint designed from data of the patient&#39;s hip joint. The acetabular guide may further include a peripheral annular rim.

FIELD

The present teachings relate to an acetabular guide and particularly to a patient-specific guide and various associated instruments.

INTRODUCTION

In an anatomy, such as a human or other animal anatomy, a portion may become damaged. A prosthetic member may be placed in the anatomy to replace the damaged portion. The present teachings are directed to a patient-specific acetabular guide and associated instruments for implanting an acetabular implant into an acetabulum of a patient for hip joint arthroplasty. The patient-specific acetabular guide may include portions that allow for performing a procedure using one of multiple user selected approaches.

SUMMARY

The present teachings provide various instruments and methods for generally preparing the acetabulum of a patient to receive an acetabular implant, such as, an acetabular cup along an alignment axis. The alignment axis may be determined and various patient-specific guides and other associated instruments may be determined and designed during a pre-operative plan using a three-dimensional reconstruction of the patient's relevant anatomy. For an acetabular procedure, the reconstruction may include a pelvis or portions thereof, including the acetabular and periacetabular areas of the pelvis. The three-dimensional reconstruction may be based on image data of a subject, such as magnetic resonance image data (MRI), computed tomography (CT) image data, ultrasound, and/or X-ray scans and prepared using commercially available imaging software.

The present teachings provide, for example, a patient-specific acetabular guide that may be used for preparing an acetabulum of a patient to receive an acetabular implant, such as an acetabular cup. The acetabular guide may have a dome-shaped body with a peripheral annular rim and an outer three-dimensional surface configured to match an acetabulum of a specific patient's acetabulum based on three-dimensional images of the patient's acetabulum acquired during a preoperative plan for the patient. A patient-specific registration guide may be permanently attached and/or removably positioned to the peripheral rim. The patient-specific registration guide may have a longitudinal bore defining a patient-specific alignment axis with an alignment orientation configured for guiding an acetabular implant for the patient during the preoperative plan of the patient. The registration guide has a patient-specific undersurface configured to mate with a corresponding portion of a periacetabular surface and/or acetabular rim surface of the acetabulum of the patient.

In some embodiments, the acetabular guide may include a plurality of spaced-apart registration flanges (also referred to as fingers or extensions). Each registration flange may extend from and be attached to the peripheral rim of the acetabular guide. Each registration flange has a patient-specific undersurface configured to mate with a selected surface of the acetabular rim of the patient's acetabulum.

The present teachings also provide a method for hip joint arthroplasty. The method includes inserting a patient-specific acetabular guide into an acetabulum of a patient. A patient specific undersurface of a dome-shaped body of the acetabular guide mates substantially as a negative of a corresponding surface of the acetabulum. The guide may include at least one patient-specific registration flange that extends from a peripheral rim of the acetabular guide over a portion of an acetabular rim of the acetabulum.

The guide and method includes inserting an alignment pin into the patient's bone through a bore of a patient-specific registration guide. The patient-specific registration guide may be removably attached to the peripheral rim of the acetabular guide. The patient-specific registration guide is preoperatively configured to define a patient-specific alignment orientation for inserting an acetabular implant. The method includes removing the acetabular guide without removing the alignment pin and inserting an acetabular implant along an orientation generally parallel to the alignment pin. The parallel alignment may, however, include error from a user or manufacturing tolerances, and/or selective non-parallel alignment by the user.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

FIG. 1A is a plan view from a first perspective of a guide according to various embodiments;

FIG. 1B is a plan view from a second perspective of the guide of FIG. 1A, according to various embodiments;

FIG. 1C is side plan view of the guide of FIG. 1A;

FIG. 2 is a partial environmental plan view of the guide of FIG. 1A being placed, according to various embodiments;

FIG. 3A is a partial environmental plan view from a first perspective of the guide of FIG. 1A, according to various embodiments;

FIG. 3B is a partial environmental plan view from a second perspective of the guide of FIG. 1A, according to various embodiments;

FIG. 4 is a pin guide, according to various embodiments;

FIGS. 5A and 5B are plan partial environmental views of alignment pins placed with the guide and an instrument;

FIGS. 6-8 are plan partial environmental views of alignment pins placed with the guide and an instrument with an instrument guide, according to various embodiments; and

FIG. 9 is a partial environmental plan view of a prosthesis placed in a pelvis.

Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses.

The present teachings generally provide patient-specific acetabular alignment guides, inserters and/or other associated instruments for use in orthopedic surgery, such as, for example, in joint replacement or revision surgery for the hip. The patient-specific alignment guides and associated instruments may be used either with conventional or with patient-specific implant components prepared with computer-assisted imaging methods based on medical scans of the specific patient.

As described in U.S. Pat. No. 8,092,465, issued Jan. 1, 2012, and U.S. Patent Application Publication No. 2012/0226283, filed Feb. 21, 2012, both of which are incorporated by reference herein, during a preoperative planning stage, imaging data of the relevant anatomy of a patient may be obtained at a facility, including a doctor's office. The imaging data may include, for example, a detailed scan of a pelvis, hip, knee, ankle or other joint or relevant portion of the patient's anatomy. The imaging data may be obtained using an MRI, CT, and X-Ray, ultrasound or any other imaging systems. The imaging data obtained may be used to construct a three-dimensional computer image of the joint or other portion of the anatomy of the patient and prepare an initial preoperative plan that may include bone or joint preparation, such as planning for resections, milling, reaming, broaching, as well as implant selection and fitting, design of patient-specific guides, templates, tools and alignment protocols for the surgical procedure. Additionally, physical modes of the patient's joint and associated bones may be prepared for visualization and trialing of the guides and implants prior to the surgical procedure.

Computer modeling for obtaining three-dimensional computer images of the relevant patient's anatomy may be provided by various computer aided drafting (CAD) programs, applications and/or software commercially available from various vendors or developers, such as, for example, from by Object Research Systems or ORS, Montreal, Canada. The computer modeling program or other application may be configured and used to plan a preoperative surgical plan, including planning various bone preparation procedures, to select or design/modify implants and design patient-specific guides and tools. The patient-specific guides and tools may include patient-specific prosthesis components, and patient-specific tools, including reaming, broaching, milling, drilling or cutting tools, alignment guides, templates and other patient-specific instruments.

The preoperative plan may be stored in any computer storage medium, in a computer file form or any other computer or digital representation, including three-dimensional graphical files or digital data sets. The preoperative plan, in a digital form associated with interactive software or other application, may be made available via a hard medium, a web-based or mobile or cloud service, or a portable device that may have access to a cellular network. The plan may be provided via the various systems or media to the surgeon or other medical practitioner, for review. Using the interactive software or application, the surgeon may review the plan, and manipulate the position of images of various implant components relative to an image of the anatomy. The surgeon may modify the plan and send it to the manufacturer with recommendations or changes. The interactive review process may be repeated until a final, approved plan, is sent to a manufacturing facility for preparing actual physical components. In various embodiments, physical and digital patient-specific bone models, guides, and instruments may be provided preoperatively to the surgeon for trialing and marking.

After the surgical plan is approved by the surgeon, patient-specific implants and associated tools, including, for example, alignment guides, cutting/milling/reaming/broaching or other tools for the surgical preparation of the joint or other anatomy portion of the specific patient may be designed using a CAD program or other three-dimensional modeling software, such as the software provided by Object Research Systems or ORS, Montreal, Canada, for example, according to the preoperative surgical plan. Patient-specific guides and other instruments may be manufactured by various stereolithography methods, selective laser sintering, fused deposition modeling, or other rapid prototyping methods, and/or computer controlled machining. In some embodiments, computer instructions of tool paths for machining the patient-specific guides and/or implants may be generated and stored in a tool path data file. The tool path data may be provided as input to a CNC mill or other automated machining system, and the tools and implants may be machined from polymer, ceramic, metal or other suitable material depending on the use, and sterilized. The sterilized tools and implants may be shipped to the surgeon or medical facility for use during the surgical procedure.

Patient-specific implants, guides, templates, tools or portions thereof are defined herein as those constructed by a preoperative plan for a specific patient from three-dimensional images of the specific patient's anatomy reconstructed from preoperative image scans of the patient. The patient-specific components are constructed to closely conform and mate or match substantially to a surface of the patient's anatomy. The mating or matching is generally as a negative mold, negative surface, or inverse or mirror surface of corresponding surface portions of the patient's anatomy. The anatomical surfaces may include bone surfaces with or without associated soft tissue, such as articular cartilage, depending on the particular procedure, implant and tool use. Minute irregularities, such as those that would not affect placement of the guide, of the patient's joint surfaces need not be mirrored.

As discussed above, patient-specific alignment guides and implants are generally configured to match the anatomy of a specific patient and fit/register to the patient in only one position on a corresponding surface of the specific patient because anatomic features that are unique to each patient may function as landmarks and may guide placement of the alignment guide or implant in only one position without the need of intraoperative image navigation. patient marking, or other intraoperative guidance. The patient-specific alignment guides are generally configured and manufactured using computer modeling based on the 3-D anatomic image of the patient and have an engagement surface that is made to conformingly contact and match, as discussed above, to a corresponding surface of a three-dimensional image/model of the patient's bone surface (with or without cartilage or other soft tissue), by the computer methods discussed above.

Generally, the patient specific guide has an exterior surface that directly contacts a selected portion of a selected region of a specific patient's anatomy. For example, a patient specific guide can include an exterior surface (e.g. an external dome surface of an acetabular guide) that directly contacts about 80% of the patient's anatomy (e.g. a specific patient's acetabulum) when properly positioned, including about 90% contact, and about 98% contact. The exterior surface of the patient matched guide may, therefore, substantially mate with the selected portion of the anatomy. It is understood, however, that certain exterior portions of a patient specific guide may not have substantial contact with the patient, while other portions are designed to ensure contact even when other portions are not contacting the patient. Thus, a patient matched guide may have portions that are substantially patient matched and have or may achieve the selected amount of contact with the patient.

The patient-specific alignment guides may include one or more custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that may be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting pins or other fasteners according to a surgeon-approved pre-operative plan. The patient-specific alignment guides may be used in minimally invasive surgery, and also in surgery with multiple minimally-invasive incisions. Various alignment guides and pre-operative planning procedures are disclosed in U.S. Pat. No. 8,092,465, issued Jan. 10, 2012; U.S. Pat. No. 8,070,752, issued Dec. 6, 2011; U.S. Pat. No. 8,133,234, issued Mar. 13, 2012; U.S. Publication No. 2009/0024131, published Jan. 22, 2009; U.S. Publication No. 2008/0114370 dated May 15, 2008, now U.S. Pat. No. 8,298,237, issued Oct. 30, 2012; U.S. Publication No. 2011/0224674, published Nov. 15, 2011; U.S. Publication No. 2011/0184419, published Jul. 28, 2011; and U.S. Publication No. 2012/0226283, published Sep. 6, 2012, all patents and applications are incorporated herein by reference.

With reference to FIGS. 1A and 1B, an acetabular guide 100 is illustrated. The acetabular guide 100 may include various portions that are similar to the acetabular guide described in U.S. patent application Ser. No. 13/711,306 filed on Dec. 11, 2012, incorporated herein by reference. The acetabular guide 100 may include an exterior surface 102 that may substantially match a patient's anatomy, as discussed above. Generally, the exterior surface 102 may be formed to mate with an anatomy of the patient, such as an acetabulum, to engage the acetabulum to register or position the acetabular guide 100 relative to the acetabulum of the subject in a single selected location and orientation. The exterior surface 102 may be designed and formed based upon image data acquired of the subject in the preoperative planning session. In addition to the exterior surface, one or more registration flanges 110 may be formed to extend from an upper or peripheral rim 112 of the guide 100. The registration flanges 110 may engage an acetabular rim of the acetabulum of the patient to assist in registration of the guide 100 relative to the patient. In addition, the registration flanges 110 may assist in guiding the guide 100 relative to the acetabulum to ensure appropriate placement of the guide 100 in the acetabulum for performing a procedure.

In addition, guide 100 may include various additional portions, such as those disclosed in the U.S. patent application Ser. No. 13/711,306 filed on Dec. 11, 2012, incorporated herein by reference. Briefly, various additional portions may include passages or windows 114 formed through the surface 102 of the guide 100 to assist in viewing portions of the anatomy, such as the acetabulum. In addition to the windows 114, one or more fixation bores 116 may also be defined to assist in fixing the guide 100 relative to the subject. For example, screws may be passed through the passages 116 to assist in fixing the guide 100 relative to the subject. In addition, various passages may be provided through the registration flanges 110, the rim 112, or other portions of the guide to assist in fixing the guide 100 relative to the subject. Pins, tacks, screws, and other members may be passed through selected portions of the guide to fix the guide 100 to the subject. It is understood, however, that various fixation members are not required to assist in holding or fixing the guide 100 relative to the patient. The registration of the guide 100 relative to the patient may provide appropriate positioning and fixation of the guide 100 for positioning an alignment pin, as discussed further herein.

The guide 100 further includes an interior surface 120 through which the windows 114 and the passages 116 may be formed as well. Additionally, one or more posts or positioning member 130 and 140 may extend from an interior surface of the guide 100. The positioning post 130 may be an augment post to the main or central positioning post 140. Generally, the main post 140 may extend from a center or along a central axis of the guide 100 and define a central alignment axis A for the guide 100. Generally, the main and central post 140 may define the alignment axis A that has been predetermined relative to the subject or patient during the planning process. Generally, the alignment axis A may be used in positioning or ensuring the position of a pin guide, as discussed further herein, relative to the acetabulum or pelvis for positioning an alignment pin 150, as discussed further herein. The alignment pin can be a drill pin, a puncture pin, or appropriate elongated member. The alignment pin 150 may be formed or positioned along an auxiliary axis A₁, which may be formed substantially parallel to the axis A through the central post 140. The two axes, A₁ and A, ensure that the alignment pin 150 is positioned within the pelvis at a preselected orientation for aligning various instruments and prostheses, as discussed further herein. The alignment pin 150 is positioned through a moveable, articulable alignment or pin guide 160. The pin guide 160 may be formed of a selected material, such as a metal or metal alloy material to fit over the central post 140. The remainder of the guide 100 may be formed substantially of a polymer that is an easily formed material, as discussed above. The pin guide 160, however, may resist wear and deformation due to positioning of the alignment pin 150 relative to the pin guide 160.

The pin guide 160 may be positioned relative to the guide 100 via a central guide bore formed in an arm boss 162. The arm boss 162 may engage the central post 140 and rotate about the central post 140 generally in the direction of Arrow 164. The movement of the pin guide 160 generally in the direction of Arrow 164 allows for movement of a pin bore 166 formed through a body 168. The alignment pin 150 may pass through the bore 166. The body 168 may be connected to a first arm portion 170 that may cooperate with a second arm portion 172. The first arm portion 170 may articulate or translate relative to the second arm portion 172 generally in the direction of arrow 174. For example, the first arm portion 170 may be at least partially received within and moveable relative to the second arm portion 172. Accordingly, the body 168 may rotate relative to the central post 140 and may also translate longitudinally relative to the central post 140. Generally, the movement of the body 168 may be along or relative to the rim 112 of the guide 100 as well.

According to various embodiments, the pin guide 160 may be positioned relative to the central bore post 140 such that the guide boss 162 is aligned along the axis A. The first arm member 170 and the second arm member 172 may then extend over a first guide surface 180 defined by a portion of the rim 112. A second guide surface 182 may also be formed on the rim 112, as discussed further herein. Nevertheless, the pin guide 160 may rotate relative to the central post 140 and be guided or rest on the first guide surface 180. Additionally, the first or second guide arms 170, 172 may translate to alter a distance of the guide body 168 transversely relative to the central post 140.

The alignment axis A may be defined during the preoperative planning period to assist in aligning various instruments and implant portions, as discussed further herein. Accordingly, the position of the central post 140 may also be defined relative to the axis A. The pin guide 160 may be formed to have a relationship relative to the axis A such that the axis A₁ is substantially parallel or at a selected angle relative to the axis A of the guide 100. As the alignment pin 150 is passed through the guide bore 166 of the pin guide 160, the alignment pin 150 is also positioned along the axis A₁ into the patient's anatomy.

The pin guide 160 may be positioned relative to the guide 100 along the first guide surface 180 and/or the second guide surface 182 during a selected procedure. In various embodiments, the first guide surface 180 may be provided for an anterior approach to positioning the alignment pin 150 and further performing an acetabular implantation procedure. The second guide surface 182 may be provided for a posterior-lateral approach for the same, such as positioning the alignment pin 150 and/or performing an acetabular procedure. Accordingly, the guide 100 may be provided for performing an anterior and a posterior-lateral procedure. The pin guide 160 may be the same for both approaches where the guide body 168 with the bore 166 there through is formed to be positioned relative to the guide 100 for either approach. The bore 166 may, however, also be provided to have a different selected axis A₁ for either the anterior approach or a posterior-lateral approach. The different angle may be caused due to interaction with the guide surface 180 or 182 or rotation of the pin guide 160 about the central post 140.

With a continued reference to FIGS. 1A-1C, and additional reference to FIGS. 2A-3B, the guide 100 may be positioned relative to a pelvis 200 of a subject, such as being positioned within an acetabulum 202. The guide 100 may further engage an acetabular rim 204 relative to the acetabulum to assist in positioning and registering the guide 100 relative to the acetabulum 202. The guide 100, once positioned with the acetabulum 202, may be used to place the alignment pin 150 within the pelvis for guiding a procedure.

The guide 100 may be inserted with an inserter 220 that includes a shaft portion 222 and a guide engaging portion 224. The guide engaging portion 224 may be provided separately or as an integral single piece member with the shaft portion 222. Nevertheless, the guide engaging portion 224 may include a main body 226 that may define an internal bore to receive and engage the central post 140. Fingers or legs 228 and 230 may extend transverse to the shaft portion 222 to engage the secondary post 130. The two legs 228, 230 may be formed substantially parallel to engage the secondary post 130. Accordingly, the inserter 220 may engage the guide 100 to securely hold the guide 100 while positioning in the acetabulum 202 of the pelvis 200.

Inserter 220 may engage the guide 100 to position it within the pelvis 200 of the patient. As the inserter 220 engages the acetabular guide 100 to rotationally fix it relative to the insert 220, the inserter 220 may be used to ensure appropriate location and orientation of the guide 100 relative to the anatomy. For example, the guide 100 may be rotated to ensure proper registration and engagement of the guide relative to the subject. Accordingly, once the inserter 220 engages the guide 100, the guide may be rotated, located and moved, or otherwise appropriately moved relative to the pelvis 200 to ensure proper registration to the pelvis 200.

Once positioned in the acetabulum 202, the guide 100 may be used to position the alignment pin 150 into the pelvis 200. It is understood, that the anatomy of the patient may define various anatomical planes including an axial plane (AP), a sagittal plane (SP) and an anterior pelvic plane (APP), as illustrated in FIGS. 3B. The alignment pin 150 may be positioned through the pin guide 160, including the guide body 168, to position the alignment pin 150 within the pelvis 200.

As discussed above, the pin guide 160 may be moved along the respective surfaces 180, 182 to position the alignment guide body 168 at a selected location. Movement of the alignment body 168 by a surgeon may assist in ensuring that the alignment pin 150 is positioned in a portion of the anatomy that is appropriately strong and dense enough to hold the alignment pin 150 for a procedure. Although the alignment pin 150 is positioned along the axis A₁, which is generally parallel to the axis A of the main post 140 of the guide 100, the pin 150 may be positioned at a plurality of locations relative to the acetabulum 202 to ensure the appropriate fixation relative to the acetabulum 202. Accordingly, once an approach is determined and begun, the pin guide 160 may be positioned relative to the first guide surface 180 for performing an anterior approached and/or relative to the guide surface 182 for performing a posterior-lateral approach. The angle of the alignment pin 150 may be substantially maintained relative to the central post 140 of the guide 100, but the translated position of the guide body 168 may be provided relative to the central post 140 for positioning the guide 100.

As discussed above, with continued reference to FIGS. 3A and 3B and further reference to FIGS. 1A-2, once the guide 100 is positioned and restored within the acetabulum 202 of the patient, the alignment pin 150 may be passed through the pin guide 160 into the pelvis 200. First, however, the body 168 may be moved relative to the guide 100 via rotation around the main post 140 due to the boss 162 and articulated for distance from the center post 140 due to articulation of the first arm portion 170. Therefore, the user may rotate the body 168 around the central post generally in the direction of the Arrow 164 to position the body 168 at a selected position relative to the acetabulum 202. For example, the first arm portion 170, the second arm portion 172, or both may be moved along the respective surfaces 180 and 182 to position the guide body 168 for either an anterior or posterior-lateral procedure. Further, the positioning of the body 168 may be fine-tuned based upon the patient's anatomy as viewed by the user. Although the procedure may be pre-planned, the user may determine a specific site for placing or positioning the alignment pin 150 based upon a direct visual inspection of the anatomy. Moreover, the surgeon may alter the plan during the procedure which may require or allow for altering a position of alignment pin 150 relative to the central post 140 of the alignment guide 100. Additionally, the alignment pin 150 may be positioned at a distance from the central post 140 that may be selected during an operative procedure.

The surgeon or user may determine to perform an anterior or posterior-lateral procedure intraoperatively. Accordingly, once the surgeon begins a procedure, such as making an initial incision into the patient, the surgeon may determine whether to complete the procedure from an anterior or posterior-lateral approach. Accordingly, the single guide 100 may be formed to allow for a positioning of the alignment pin 150 based upon either of the anterior or posterior-lateral approaches due to alignment of the body 168 along the axis A₁ with the access A of the central post 140.

As illustrated in FIG. 3A, the axis A of the central post 140 on which the guide boss 162 is positioned allows for the axis A₁ of the body 168, therefore, the axis of the alignment pin 150, to be aligned with the central axis A. Thus, the position of the body 168 may be positioned at any point around the central post 140 while maintaining the parallel or other selected orientation of the axis A of the central post 140 and the axis A₁ of the body 168. It is understood that the axis A₁ of the body need not be parallel with the axis A of the central post 140. For example, the axis A₁ of the body 168 may be planned to be at an angle relative to the central axis A of the central post 140. The positioning of the implant, reamer, and other tools relative to the alignment pin 150 may be selected to be achieved based upon the position of the angle of the alignment pin 150.

Once the body 168 is positioned at a selected orientation by the user, the pin 150 may be driven into the pelvis. Generally, the pin 150 may be positioned near the rim 204 of the acetabulum 202. The pin 150 may be moved into the anatomy using any appropriate mechanism, such as a drill motor 250. The drill motor 250 may be an appropriate drill motor, such as those generally known in the surgical arts. The drill motor may include a chuck 252 to engage and drive the alignment pin 150 into the anatomy through the bore 166 of the body 168.

Once the pin 150 is positioned within the pelvis 200, the alignment guide 100 may be removed from the pin 150. The pin guide 160 may be moved along the length of the pin 150 to remove the pin guide 160 from off the pin 150 and the patient. The alignment guide 100 may be removed in any selected direction as the alignment guide 100 is not directly connected to the pin 150. That is, the alignment guide 100 is interconnected with the pin 150 via the pin guide 160. It is understood, however, that the pin guide 160 may be formed as an assembly with the remainder of the alignment guide 160, such as forming a pivot at the central post 140 which forms the boss 162 of the pin guide 160.

In addition to a single body 168, as illustrated above, a dual body pin guide 160′ may be provided with a single first arm portion 170′, as illustrated in FIG. 4. The body, therefore, may include a first body 168 a and a second body 168 b. Both of the bodies may include bores 166 a and 166 b passing therethrough. Each of the bores 166 a and 166 b may be formed to be substantially parallel to the central axis A of the central post 140. Nevertheless, the dual body 168 a and 168 b including the separate bores 166 a and 166 b that may be used to guide two alignment pins at a fixed and known relationship to one another and relative to the anatomy of the pelvis 200 during a procedure. It is understood, therefore, that a first alignment pin 150 and a second alignment pin 151, as illustrated in FIG. 5B, may be provided relative to the anatomy. The pin guide 160′ may include other portions similar to the pin guide 160 as discussed above. For example, the first arm portion 170′ may articulate relative to a second arm portion 172′ and a central boss 162′. The central boss 162′ may include a central bore or blind bore 163 that may fit over the central post 140 to allow for a rotation of the pin guide 160′ relative to the alignment guide 100.

With continued reference to FIGS. 1-4 and additional reference to FIGS. 5A-6, once the alignment guide 100 is removed, the alignment pin 150 and/or the alignment pin 151 may be positioned and maintained within the anatomy of the pelvis 200. An instrument, such as a reamer or insertion handle 300 may then be positioned relative to the alignment pin 150 for performing further portions of the procedure, such as reaming the acetabulum 202 and/or positioning an acetabular implant 400 (FIG. 9) within the reamed or prepared acetabulum 202.

The alignment pins 150 may provide direct alignment for the instrument 300 or, in the alternative, one or more secondary alignment pins 310 may be positioned relative to alignment pin 150 to provide direct alignment of the instrument 300. The secondary alignment pins 310 may be connected directly to the alignment pin 150 or be interconnected with the alignment pin 150 via a secondary guide 320 and formed as an appropriate elongated member. The secondary guide 320 may include a throughbore 330 that passes over the pin 150. The secondary guide 320 may then further include a second throughbore or blind bore 340 into which the secondary alignment pin 310 may be positioned. The secondary alignment pin 310 may be positioned along an axis B that is preplanned for alignment of the instrument 300 along axis B′. It is understood, however, that if the axis A₁ of the alignment pin 150 may also be the alignment axis for the instrument 300, thus the secondary alignment pin 310 is provided simply for an example that the alignment pin 150 need not provide the direct alignment guide for the instrument 300.

The instrument 300 may be visually aligned with the secondary alignment pin 310 and/or the alignment pin 150 for performing various portions of the procedure, such as reaming and/or placement of an acetabular prosthesis. In addition to or as an alternative to the visual alignment of the instrument 300 to the alignment pin 310, a physical alignment guide 360 may also be provided, as illustrated in FIG. 6. The physical alignment guide 360 may include a physical and substantially rigid attachment to the instrument 300, such as via an attachment collar 362. The alignment guide 360 may further include a groove and/or shoulders, or other engagement portion 364 to engage the alignment pin 310. Accordingly, a physical connection or contact between instrument 300 and the alignment pin 310 may be provided to ensure proper alignment of the instrument 300 to the alignment pin 310.

The engagement shoulder 364 may be provided as substantially open to allow for movement of the instrument 300 relative to the alignment pin 310. The instrument alignment guide 360 does not completely surround at least a portion of the alignment pin 310. That is, the instrument alignment guide 360 can be pulled away in a direction other than axially along the length of the alignment pin 310.

According to various embodiments, as illustrated in FIG. 7, however, an instrument alignment guide 380 may be provided that engages the instrument 300 at the alignment collar 362. The alignment guide 380 may include an elongated cylinder 384 that includes a hollow central bore 386. The hollow or central bore 386 may surround the secondary alignment pin 310. Thus, the alignment guide 380 is generally removable form the alignment pin 310 through axial movement. The alignment pin 310 is held within the alignment guide 380 in all lateral directions.

An interior diameter of the internal bore 386 may be provided at a selected dimension relative to an external diameter or dimension of the secondary alignment pin 310. For example, the interior diameter of the bore 386 may be substantially equal to an exterior diameter of the secondary alignment pin 310. Accordingly, once the alignment guide 380 contacts or interconnects with the secondary alignment pin 310, substantially little movement of the alignment guide 386 relative to the pin 310 may be provided. Accordingly, the instrument 300 may be held substantially rigid relative to the alignment pin 310.

Alternatively, the interior bore 386 may include an interior diameter that is some amount greater than the exterior diameter of the alignment pin 310. For example, the interior diameter of the bore 386 may be 10%, 20%, 50%, or a selected amount greater than the exterior diameter of the alignment pin 310. As one example, the interior diameter of the bore 386 may be about 1 millimeter (mm) to about 10 mm, including about 2 mm to about 5 mm, and further including about 3 mm greater than the external diameter of the alignment pin 310.

If the internal diameter of the bore 386 is greater than the exterior diameter of the alignment pin 310, the alignment guide 380 may move transverse relative to the alignment pin 310 some limited amount. The transverse or lateral movement, however, is limited by the internal diameter of the guide 380. Thus, complete removal is limited to axial motion of the guide 380 from the pin 310. When the alignment guide 380 may move transverse relative to the alignment pin 310 of the instrument 300 may also be moved relative to alignment pin 310. The movement of the instrument 300 relative to the alignment pin 310 may allow for user selection of variations from a rigid and preplanned procedure. Accordingly, a user may determine intraoperatively a selected or appropriate alignment of the instrument 300 relative to the acetabulum 202 that has minor variations from the preselected and planned orientation of the alignment pin 150 and/or the alignment pin 310.

According to various embodiments, an alignment guide 390 is illustrated in FIG. 8. The alignment guide 390 may be similar to the alignment guide 380 save that the cylinder at 384 may include one or more ring members 392 rather than one elongated cylinder. Each of the rings 392 may also define an internal diameter 394 that has a relationship in size to an exterior diameter of the alignment pin 310. The relationship of the internal diameter 394 relative to the external diameter of the alignment pin 310 may be similar to that of the cylinder 384 having the internal diameter 386 of the bore. Accordingly, a derailed discussion thereof is not provided here. Nevertheless, the rings can provide limited transverse movement while maintaining the pin 310 within the rings. Complete removal of the guide 390 from the pin 310 can be limited to axial movement of the guide 390 relative to the pin 310.

The alignment guide 390 may be interconnected with the instrument 300 via the attachment collar 392, as discussed above. Thus, an alignment guide, according to various embodiments may be provided to interconnect or cooperate with the alignment pins 310 and/or 150, 151 to allow for a physical determination of an alignment of the instrument 300 relative to the respective pins.

With reference to FIGS. 1A-8 and additional reference to FIG. 9, the instrument 300 may be used for reaming and/or placement of an acetabular prosthesis 400. The prosthesis 400 may be positioned within the prepared acetabulum 202 of the pelvis 200. The acetabular prosthesis 400 may be positioned with the instrument 300 by alignment with the alignment pins 150 and/or 151 and/or 310. The acetabular prosthesis 400, therefore, may be positioned along the axis or parallel to the axis A of the central post 140, as discussed above. It is understood, however, that the acetabular prosthesis 400 may be positioned in any appropriate and preselected orientation relative to the axis A due to the positioning of the pin guide 160 relative to the central post 140, the positioning of the secondary guide 320 relative to the alignment pins 150 and/or 151, and positioning of the instrument via the guide 360, 380, and/or 390 relative to the alignment pin 310 and/or 150, 151. Nevertheless, the alignment guide 100 may be designed and manufactured to interact with the anatomy of the patient in the acetabulum 202 and/or the rim 240 to prepare the acetabulum 202 to achieve a preselected orientation of the acetabular prosthesis 400 relative to the pelvis 200 for a specific patient.

Various patient-specific guides, secondary guides, reamers, guide handles, inserters, impactors, support devices, electronic positioners and other instruments may be used in various combinations and based on surgeon preferences or patient and preoperative or intraoperative circumstances for preparing an acetabulum and guiding and implanting an acetabular implant along a preoperatively determined alignment orientation. In this respect, tools and instrumentation providing redundant functionality and of different embodiments may provide to the surgeon in a kit or per surgeon's request.

For example, adaptors and other instruments described above may be provided and used in various combinations within the scope of the methods described herein.

The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the present teachings without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations may be made therein without departing from the spirit and scope of the present teachings as defined in the following claims. 

1.-17. (canceled)
 18. A method of placing a guide pin near an acetabulum with an acetabular guide system, comprising: positioning an exterior curved surface of an acetabular guide in an acetabulum, where the exterior curved surface has a geometry that substantially matches the acetabulum of a specific patient based on a geometry of the acetabulum of the specific patient; interconnecting a pin guide to a central post; rotating the pin guide about the central post to position a guide body of the pin guide relative to the central post.
 19. The method of claim 18, further comprising: selecting a position of the guide body relative to the central post and rotating the guide body to the selected position; and resting the pin guide of a selected rim portion of the acetabular guide.
 20. The method of claim 19, further comprising: selecting the selected rim portion from a first rim portion and a spaced apart second rim portion; wherein each of the first rim portion and the second rim portion include a surface to support the pin guide.
 21. The method of claim 19, further comprising: moving a first arm portion longitudinally relative to a second arm portion of the pin guide; wherein moving the first arm portion longitudinally relative to the second arm portion of the pin guide linearly translates the guide body relative to the central post.
 22. The method of claim 21, further comprising: fixing an alignment pin near the acetabulum through the guide body at the selected position.
 23. The method of claim 22, further comprising: providing an instrument guide with a bore having an internal diameter greater than an external diameter of the alignment pin.
 24. The method of claim 23, further comprising: moving an instrument from an axis defined by the alignment pin at least due to the internal diameter of the bore being greater than the external diameter of the alignment pin.
 25. The method of claim 24, further comprising: placing an acetabular prosthesis in the acetabulum with the instrument connected to the instrument guide while the instrument guide is connected to the alignment pin.
 26. A method of placing a guide pin near an acetabulum with an acetabular guide system, comprising: providing an exterior curved surface of an acetabular guide to have a geometry to substantially match the acetabulum of a specific patient based on a geometry of the acetabulum of the specific patient; providing a central post extending from an interior surface of the acetabular guide along a post long axis; and providing a pin guide configured to be connected to the central post to rotate about the central post to position a guide body of the pin guide relative to the central post.
 27. The method of claim 26, further comprising: forming a first flat rim portion of the acetabular guide; forming a second flat rim portion of the acetabular guide; wherein the first flat portion is positioned and an anterior approach procedure and the second flat rim portion is positioned for a posterior-lateral approach procedure.
 28. The method of claim 26, forming the pin guide with a first arm moveable relative to a second arm to select a distance of the guide body from the central post.
 29. The method of claim 26, further comprising: forming an instrument guide to defining a central guide bore with an internal diameter; moving the instrument guide over an alignment pin, wherein the alignment pin includes an external diameter less than the internal diameter. 